The goal of this research project is to examine how children with hearing loss (HL) whose parents wish for them to be mainstreamed without a sign-language interpreter are faring in the early elementary grades. For that purpose, children with HL will be tested from kindergarten through grade four on a variety of measures evaluating psychosocial development, cognition, spoken language perception and production, reading, and writing. Results will be compared to data collected from children with normal hearing (NH) tested as part of the same protocol. All children to be tested participated in the first cycle of this project, and so were evaluated between the ages of one and four years. On all dependent language measures, means for children with HL were roughly one standard deviation below means for their typically developing peers with NH in those early years, leaving them at a disadvantage going into elementary school. The primary focus of this next cycle is to examine how these children do when they enter mainstream educational settings where language demands are expected to escalate. An increasing mismatch between the language abilities of the deaf children and the language requirements of the classroom are predicted, such that deaf children fall progressively behind academically. The four specific aims of this project are: (1) To track the speech, language, psychosocial, cognitive, and academic development of 119 children who participated in the first cycle of this project through fourth grade; (2) To test the hypothesis that CI wearers have linguistic processing problems different from those of HA wearers because of the difference in the kind of signal delivered by the two devices; (3) To examine the extent to which the pattern of deficits exhibited by children with HL is best described by the processing limitations hypothesis versus the structural deficits hypothesis; and (4) To test the hypothesis that the performance of children with HL ranges from what is measured in typically developing children with NH to what would be expected of dyslexic children with NH based on the extant literature. This project is uniquely motivated both because data will be collected from children tested from one year of age and because the selection of dependent measures arises from results emerging from the Principal Investigator's other research. PUBLIC HEALTH RELEVANCE: Recent technological advances have greatly improved prospects for children with sensorineural hearing loss, making it possible for many of these children to be educated in regular schools. Paradoxically it is precisely that shift to the mainstream that has diminished our ability to keep track of how they are doing as a result of these technologies. In this project we will follow through the early elementary grades children with and without hearing loss who were previously followed during the preschool years. These data will shed light both on what intervention strategies in the preschool years prepared children well for the language demands of regular school, and what services should be provided during the school years to facilitate language and academic success.